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WildCamp
2015 Summer Registration Form
WildCamp Nature Daycamp
for Children Ages 8-12
July 27-31 or August 3-7, 2015
9:00AM-3:30PM
Walnut Springs Farm, Meta, MO
Camper’s Name:_________________________
Address: _______________________________
City: __________________________________
Does your child have any of the following health concerns (circle all that apply):
Allergies
Diabetes
Asthma
Daily Medications
Drug Sensitivities
Seizures
Others: _____________________________________
I, ____________________________, the undersigned,
freely and voluntarily enter into the Release and Hold
Harmless Agreement with WildHeart, WildCamp and/or
Jan and George Syrigos, understanding that this is a
waiver of any and all liability(ies) from property damage
or injury which may occur in any way related to camp
activities.
State: ____________________ Zip: ________
Birth Date: ________________ Age: ________
Gender: ___________________
Name of Parent or Guardian:
______________________________________
Parent/Guardian e-mail:
______________________________________
Home phone:
__________________________________
Work phone:
__________________________________
Cell phone:
__________________________________
Signature of Parent or Guardian:
____________________________________________
Date
WildCamp Fees
Camp Fee
$129
Total due with application
Due date: May 1, 2015
Make checks payable to George Syrigos
Bringing the heart of the wild
to the heart of the child
Circle the Session you are registering for:
July 27-31, 2015
Mail this application along with your check to:
August 3-7, 2015
WildCamp
Jan & George Syrigos
212 Walnut Spring Trail
Meta, MO 65058
Phone: 573.229.8815
E: [email protected]
This form is downloadable at:
www.wildheartmusic.com
WildCamp
Nature Daycamp
Directors George & Jan Syrigos, [email protected]
Provided:
Two snacks each day
Nature exploration tools!
Nature Craft Materials
Water bottles
Thursday evening open house camp for the whole
family! 6:00-8:00PM. Hotdogs/Drinks provided.
Campers stay through into the evening.
Wear:
T-shirts and shorts
Crew socks
Sturdy hiking shoes or tennis shoes
Bring Daily:
Backpack withSack lunch
Sunscreen
Bug spray
Long pants
Swimsuit and wading shoes
Plastic bag for wet/muddy gear
Rain poncho
Directions to WildCamp:
The camp is located 1/2 mile north of Meta off of
Highway B—212 Walnut Spring Trail.
From Jefferson City going west on Highway 54.
Take Highway B/179 exit and turn left onto
Highway B. Stay on Highway B through
Wardsville and St. Thomas. At St. Thomas church,
check your odometer—go 4 miles.
Turn right on gravel private road—Walnut Spring
Trail. Stay to your right at the fork by the pond. Go
1/2 mile to WildCamp!
Syrigos cell phones: 573.645.7076 or 229.8815
www.wildheartmusic.com